Provider Demographics
NPI:1124167879
Name:GADARLA, MAMATHA REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:MAMATHA
Middle Name:REDDY
Last Name:GADARLA
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:105 JESSE COURT
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-3459
Mailing Address - Country:US
Mailing Address - Phone:973-265-8729
Mailing Address - Fax:
Practice Address - Street 1:526 BLOOMFIELD AVE STE 103
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5525
Practice Address - Country:US
Practice Address - Phone:973-239-1600
Practice Address - Fax:973-559-6188
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08121700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ119843WH9Medicare PIN